Neuromuscular and nervous systems clinical application- Alzheimer's disease

Question 1

what kind of disease is alzheimer’s? what brain structures does it affect?

Answer 1

a progressive, neurodegenerative disease that causes deterioration and irreversible damage to the cerebral cortex and subcortical structures

Question 2

pathology of alzheimer’s disease

Answer 2

neurons normally involved in acetylcholine transmission deteriorate within the cerebral cortex and amyloid plaques and neurofibrillary tangles form

Question 3

how do the presence of amyloid plaques disrupt normal cognitive and physical function?

Answer 3

amyloid plaques contain fragmented axons, altered glial cells and cellular waste that cause inflammation and further damage to the nervous system as well as smooth muscle atrophy of the arteries of the brain, predisposing them to rupture

Question 4

is there an exact, known etiology of alzheimer’s?

Answer 4

no

Question 5

what are the hypothesized causes (5) of alzheimer’s disease?

Answer 5

lower levels of neurotransmitters
higher levels of aluminum within brain tissue
genetic inheritance
autoimmune disease
abnormal amyloid processing
virus

Question 6

the risk of developing alzheimer’s increases with __ and there is higher incidence in women or men?

Answer 6

age; women

Question 7

the prevalence of alzheimer’s increases significantly over the age of __

Answer 7

80

Question 8

what are the initial signs and symptoms (3) of alzheimer’s disease?

Answer 8

difficulty with new learning
subtle changes in memory and concentration

Question 9

what are the signs and symptoms (6) of early progression of alzheimer’s disease?

Answer 9

loss of orientation
difficulty with word finding
emotional lability
poor judgement
depression
impaired ability to perform self-care

Question 10

what are the signs and symptoms (7) of the middle stages of alzheimer’s disease?

Answer 10

behavioral and motor problems:
aphasia
apraxia
agitation
perseveration
violent or socially unacceptable behaviors (wandering)
loss of ability to learn
loss of longterm memory

Question 11

what are the signs and symptoms of end stage alzheimer’s disease?

Answer 11

severe intellectual and physical destruction
vegetative symptoms: incontinence, inability to speak, functional dependence, seizure acitivity

Question 12

how is alzheimer’s currently able to be confirmed?

Answer 12

only by post-mortem biopsy revealing neurofibrillary tangles and amyloid plaques

Question 13

how is MRI a useful imaging technique for patients with alzheimer’s disease?

Answer 13

can be used to assess:
abnormalities or signs of brain atrophy associated with AD
to rule out:
other medical conditions

Question 14

what imaging technique may be used to determine brain activity and predict potential for alzheimer’s disease?

Answer 14

SPECT (single photon emission computed tomography)

Question 15

what laboratory studies may be required to rule out other diseases that may cause signs of dementia?

Answer 15

blood work
urine
spinal fluid

Question 16

what objective examinations (3) are required for diagnosis of probable alzheimer’s disease?

Answer 16

neurological examination
physical examination
neuropsychological examination

Question 17

to be diagnosed with probable alzheimer’s disease when being examined physically, neurologically and neuropsychologically, a patient must demonstrate atleast __ deficits of __, __ and related __ __ with the absence of all other __ __ or __ in consciousness that may contribute to identified deficits

Answer 17

atleast 2 deficits of cognition, memory and related cognitive functioning
absence of all other brain disease or disturbances

Question 18

what additional information (2) may provide insight into the expected speed of progression of alzheimer’s disease in a patient?

Answer 18

family history and symptoms

Question 19

what subjective information (80 should be documented during examination of a patient with probable alzheimer’s disease?

Answer 19

PMH
family history/symptoms
history of current symptoms
current health status
living environment
social history/habits
occupation
social support system

Question 20

what objective tests and measures (11) should be performed during examination of a patient with probable alzheimer’s disease?

Answer 20

A&O: mental status, learning ability, memory, motivation, mini-mental state exam, level of consciousness

resting and dynamic posture
A/PROM
muscle strength assessment
reflex integrity: DTR and pathological reflexes (Babinski, ATNR)
motor function: equilibrium and righting reactions, coordination, physical performance scales
aerobic capacity/endurance: vital signs at rest/with activity

gait/locomotion/balance: static/dynamic balance in sit/stand, gait/gait safety with/without AD, functional ambulation profile, BERG balance
self-care/home management: assess functional capacity, FIM, Barthel index
environmental/home/work barriers: analysis of current and potential barriers/hazards
ADs: analysis of components and safety of a device

Question 21

what objective measures can be taken at rest and with activity when examining a patient with probable alzheimer’s

Answer 21

vital signs

Question 22

what examination tool can be used when examining arousal, attention and cognition in a patient with probable alzheimer’s?

Answer 22

mini-mental state examination

Question 23

what examination tool can be used when examining gait and locomotion in a patient with probable alzheimer’s?

Answer 23

functional ambulation profile

Question 24

what examination tool can be used when examining balance in a patient with probable alzheimer’s?

Answer 24

BERG balance scale

Question 25

what objective tests (3) should be utilized when examining motor function in a patient with probable alzheimer's?

Answer 25

equilbrium and righting reactions coordination physical performance measures

Question 26

what reflexes should be tested when examining reflex integrity in a patient with alzheimer's disease?

Answer 26

DTRs pathological reflexes (Babkinsi, ATNR)

Question 27

what examination tools can be used when examining functional capacity (self-care, home management) in a patient with probable alzheimer's?

Answer 27

functional independence measure (FIM) Barthel index

Question 28

what does the Barthel index assess?

Answer 28

the ability of a patient to complete 10 common activities of daily living (feeding, bathing, grooming, dressing, b&b, transfers, mobility on level surfaces, stair negotiation

Question 29

what do the following scores on the Barthel index indicate: 0-20 21-60 61-90 91-99

Answer 29

0-20: total dependence 21-60: severe dependence 61-90: moderate dependence 90-99: light dependence

Question 30

what is considered the cut off score for moderate dependence on the Barthel index, with a higher score indicating less dependence?

Answer 30

60/61

Question 31

what does the functional independence measure assess?

Answer 31

assesses the functional status of a patient based on their required level of assistance (eating, grooming, bathing, dressing, toileting, b&b, transfers, gait/WC mobility, stair navigation, comprehension, expression, memory, social interaction, problem solving)

Question 32

what kind of scales are the Barthel index and FIM?

Answer 32

ordinal

Question 33

what do the following scores on the FIM indicate?

Answer 33

7- total independence 6- mod independent (device) 5- supervision (pt does 100%) 4- minimal assistance (pt does 75%+) 3- moderate assistance (pt does 50%+) 2- maximal assistance (pt does 25%+) 1- total assistance/not testable (pt does less than 25%)

Question 34

what does the BERG balance scale assess?

Answer 34

balance-risk of falling (one time or ongoing reassessment) (static, dynamic and transitional activities in sit/stand)

Question 35

what score on the BERG balance scale indicates an increased risk fo falling?

Answer 35

scores less than 45

Question 36

what is the max score on the BERG balance scale?

Answer 36

56

Question 37

what type of scale is the BERG balance scale?

Answer 37

ordinal

Question 38

what does the mini-mental state examination assess?

Answer 38

patient mental status/cognitive impairment (attention, language, memory, orientation, visuospatial proficiency)

Question 39

what do the following scores on the mini-mental state examination indicate: 0-17 18-23 24-30

Answer 39

0-17: severe cognitive impairment 18-23: mild cognitive impairment 24-30: no cognitive impairment

Question 40

what does the functional ambulation profile assess?

Answer 40

functional walking test that evaluates ambulation ability/how much assistance is required when walking in pt with neurological conditions

Question 41

what do the following scores on the functional ambulation profile indicate: 0 1 2 3 4 5

Answer 41

0- nonfunctional ambulator 1- ambulator dependent on physical assistance (cont manual contact to support body weight and maintain balance/assist coord) 2- ambulator dependent on physical assistance (cont light touch to assist balance or coordination) 3- ambulator dependent on supervision 4- ambulator dependent on level surface only 5- ambulator- independent (level, unlevel, stairs)

Question 42

patients with end-stage alzheimer's disease are at high risk for __ and __

Answer 42

infection and pneumonia

Question 43

what stage of alzheimer's is at high risk for infection and pneumonia?

Answer 43

end-stage

Question 44

what complications may patients with end-stage alzheimer's experience? why?

Answer 44

persistant vegitative state: contractures decubiti fracture pulmonary compromise

Question 45

what class and specific pharmocological agents are typically prescribed to patients with alzheimer's? at what stage are these medications most effective and most commonly prescribed?

Answer 45

cholinergics- tacrine (Cognex), donepezil (Aircept), rivastigmine (Excelon) early stages of the disease process

Question 46

what signs and symptoms (3) are collinergic pharmacological agents like (tacrine (Cognex), donepezil (Aircept), rivastigmine (Excelon)) prescribed to inhibit/alleviate/control during the early stages of alzheimer's disease progression?

Answer 46

inhibit acetylcholinesterase alleviate cognitive symptoms control behavioral changes

Question 47

collinergic drug therapy for patients with alzheimer's is typically __-term in effect lasting __-__ months

Answer 47

short-term 6-9 mo

Question 48

what should physical therapy for patients with alzheimer's generally focus on (2)?

Answer 48

maximizing patient function family/caregiver education

Question 49

what should physical therapy for a patient in the early stage of alzheimer's include (3)?

Answer 49

safety functional mobility gait training

Question 50

what should physical therapy for a patient in the later stages of alzheimer's include (3)?

Answer 50

ongoing caregiver education regarding assistance with mobility, ROM and positioning

Question 51

how can a physical therapist modify their session to best set a patient with alzheimer's up for success?

Answer 51

create an emotional and physical environment that optimizes each patients success ex. modifying home environment to make things easier to find

Question 52

why do many patients with alzheimer's eventually require a long-term alzheimer's care facility?

Answer 52

secondary to: personality changes aggressive behavior end-stage complications

Question 53

what is the likely outcome of the course of physical therapy for a patient with alzheimer's?

Answer 53

PT may be indicated intermittently throughout course of disease, but it will not alter or cease disease process progression

Question 54

what should the home exercise program for a patient in the early stages of alzheimer's include (3)?

Answer 54

activity as tolerated compensatory home strategies memory book

Question 55

what should the home exercise program for a patient in the middle, later on in the alzheimer's disease process include (3)?

Answer 55

w/ increased caregiver assistance: exercise ambulation participation in ADLs like folding laundry, making beds, assisting with dinner to avoid restlessness/wandering

Question 56

what specific home exercise program interventions help to avoid symptoms of middle stage alzheimer's like restlessness and wandering?

Answer 56

participation in ADLs like folding laundry, making beds or assisting with dinner

Question 57

alzheimer's disease is the __ leading cause of death in adults

Answer 57

4th

Question 58

what is the prognosis and course of disease for someone diagnosed with probable alzheimer's disease?

Answer 58

course of disease: chronic and progressive, on avg 7-11 years leading cause of death in patients with AD: dehydration, infection

Question 59

what is a common differential diagnosis to alzheimer's disease?

Answer 59

multi-infarct dimentia

Question 60

multi-infarct dimentia produces symptoms in a __-__ manner secondary to ongoing __ __

Answer 60

step-like cerberal infarcts

Question 61

multi-infarct dimentia is typically found in patients over the age of __ and is more common in males/females?

Answer 61

70; males

Question 62

what condition is a primary risk factor for multi-infarct dimentia?

Answer 62

HTN

Question 63

what mental health condition is common in patients with multi-infarct dimentia?

Answer 63

depression

Question 64

what other neurological deficits (2) might a person with multi-infarct dimentia experience?

Answer 64

hemiplegia emotional lability